From the Research
Intravenous immunoglobulin (IVIG) should be the initial therapy for most patients with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), except in the elderly and those with complicating medical illnesses, where plasma exchange (PE) may be used as the first-line therapy. This recommendation is based on the study by 1, which suggests that IVIG is well tolerated and easy to administer, making it a suitable first-line treatment for most patients with CIDP.
The treatment of CIDP typically involves long-term immunomodulatory therapy, which has potential side effects. Therefore, it is essential to establish a firm diagnosis of CIDP before instituting treatment. The choice of treatment should be individualized based on costs, availability, and potential adverse effects.
Some key points to consider in the treatment of CIDP include:
- IVIG, corticosteroids, and plasma exchange are all proven first-line therapies for CIDP, with similar efficacy 1.
- Prednisone is inexpensive, easily available, and of proven efficacy, making it a preferred treatment in young, otherwise healthy persons either as a first-line therapy or in association with IVIG or PE 1.
- Patients who require repeated treatment with IVIG or PE and cannot tolerate prednisone or those who require high-dose prednisone should be administered azathioprine, cyclosporin A, or cyclophosphamide, usually in combination with one of the first-line therapies 1.
- A more recent study by 2 found that the overall response rate with conventional first-line immunotherapies was 77%, comparable between IVIG and corticosteroids, further supporting the use of these treatments in CIDP.
It is also important to note that CIDP requires long-term management, and treatment aims to suppress the abnormal immune response and reduce inflammation, allowing for nerve repair and improved function. Physical therapy is also crucial to maintain muscle strength and function.
In terms of specific treatment regimens, the study by 3 found that pulsed oral methylprednisolone may be efficacious in the long-term treatment of CIDP and is relatively well tolerated. However, this study is older, and more recent evidence from 2 suggests that IVIG and corticosteroids remain the preferred first-line treatments.
Overall, the treatment of CIDP should be individualized and based on the most recent and highest-quality evidence available, with a focus on minimizing morbidity, mortality, and improving quality of life.